Editor's note, 2/06: Recent evidence indicates that IUDs are extremely safe and effective for both parous and nulliparous women. The IUD itself does not increase the risk of pelvic inflammatory disease, which can lead to infertility; rather, pre-existing STIs increase the risk of infection. Nulliparous women are slightly more likely (up to 10 percent) to expel the IUD. This causes no harm, but if expulsion occurs, the woman will no longer be protected against pregnancy. See the World Health Organization's Medical Eligibility Criteria for Contraceptive Use, 2004, and FHI's Quick Reference Chart that summarizes them.
Young women and women who have not yet had children can generally use intrauterine devices (IUDs), but providers should be cautious. Because these groups face increased risk of IUD expulsion and pelvic inflammatory disease (PID), the IUD generally is not recommended as the first method of choice.1
For adolescents who need family planning, the IUD does have distinct advantages: It is nonhormonal and requires minimal compliance after insertion. The risks of infertility, however, should be considered before recommending this method to younger women.
"Age by itself is not a contraindication for IUD use," says Dr. Roberto Rivera, FHI's corporate director of international medical affairs. "There is no biological reason to say a young woman is at higher risk than an older woman. An older woman and a younger woman with the same sexual behavior have the same risks."
While there is no medical rationale against IUD use by adolescents, demographic studies show that women under age 25 have a higher incidence of sexually transmitted diseases (STDs) than older women, who are more likely to be married or living in union. Younger women are not biologically more susceptible to STDs; however, lifestyles and sexual behavior, such as multiple sexual partners, may put them at greater risk.
For the majority of IUD users, fertility typically returns immediately or soon after the device is removed, and duration of use does not appear to affect a woman's ability to conceive. One study in New Zealand found that within 48 months of IUD removal, 91.5 percent of women, who had never before been pregnant, had conceived, while 95.7 percent of those who had been pregnant before IUD use had conceived.2
Family planning providers should help clients understand how contraceptive use may affect their risks of PID and their future fertility. In spite of risks of infertility to young women and nulliparous women, the decision about which method to use ultimately should be made by the woman.
-- Barbara Barnett
Footnotes
- Curtis KM, Bright PL, eds. Recommendations for Updating Selected Practices in Contraceptive Use: Results of a Technical Meeting, Volume I. Chapel Hill: Technical Guidance Working Group, U.S. Agency for International Development, 1994. Improving Access to Quality Care in Family Planning: Medical Criteria for Initiating and Continuing Use of Contraceptive Methods. Geneva: World Health Organization, 1995.
- Wilson JC. A prospective New Zealand study of fertility after removal of copper intrauterine devices for contraception and because of complications: A four-year study. Am J Obstet Gynecol 1989;160(2):391-96.
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